July24, 2017

Mr. President, I thank my colleague from Massachusetts for her good words and her advocacy. I rise today to join her and my colleague on the floor in sharing the concerns that I continue to hear every single day in my state. Whether it's just simply walking parades as I did in Stillwater, Minnesota, where people would come up off the sides or on the 4th of July--a family with a child with down syndrome just coming off the side of the parade and grabbing me and saying we need health care for our son. We cannot cut him off. We cannot make these drastic draconian reductions to Medicaid because he is the face for Medicaid.

So right now, as far as I know, we have many versions of this healthcare bill. I think I heard this version referred to as option c, but I was thinking that's not really correct because we have had options a and b. Those were the two house healthcare bills. Then we had options c and d, which were the two Senate healthcare bills. Then we went to option e, which was back to the idea of repealing without a replacement. And now as far as I know, after doing a, b, c, d, and e, we are at plan f. Right? So I think it's time to set a new course and that is to work together for a better grade for the American people and a better health care plan, which means working across the aisle to make changes to the Affordable Care Act.

So the Minnesotans I have heard from, they don't like a, b, c, d, e, or f. On Friday, in fact, I received a letter signed by 121 different Minnesota healthcare organizations talking about these past proposals. And they said this, "Minor changes or amendments will not change the ultimate impact of these bills and their deep and devastating impact on Minnesota and its citizens." So what are these groups? Well, pretty mainstream groups. AARP Minnesota, our children's hosptal, the Autism Society of Minnesota, our nursing homes, the Minnesota Hospital Association, the Minnesota Nurses Association, Mental Health Minnesota, our Catholic Health Association, our addiction treatment professionals, and many, many more.

What these groups--as different as they may be in their missions and the work that they do and who belongs to them and where they live--what they have in common is that they are dedicated to taking care of the health and well-being of Minnesotans and they are scared about what could happen if any of these proposals- a, b, c, d, e, or f are passed. They have seen that the nonpartisan Congressional Budget Office estimates that a number of these bills would mean over 20 million--if not all of them, over 20 million people losing their health insurance. Medicaid getting cut by more than $700 billion, and out-of-pocket costs skyrocketing. Deductibles for a benchmark plan would reach $13,000 by 2026. They have seen that the CBO has found a repeal bill without a replacement would be even worse. 32 million people would lose their coverage and premiums would double. So I understand why these Minnesota healthcare organizations are scared about these bills.

But the people that are even more scared are the citizens of my state that depend on the Affordable Care Act for their healthcare. Now, we all know as I said the day it passed, that the Affordable Care Act was a beginning and not an end. You cannot pass a major piece of legislation like that without making changes over time. Unfortunately, with the exception of a few minor things, we have basically been blocked from making changes because what's also always being thrown at us is this idea of simply repealing everything and causing chaos. Now is the time after the sentiment of the American people is quite clear. You don't have to look at a poll to know that. All you have to do is walk down the main street in any parade in our state. Now is the time for us to work across the aisle on some positive changes. So what are those changes?

Well, for one, we know that we must bring some certainty to the exchanges, stabilize the market. I see the Senator from New Hampshire here, the former Governor of New Hampshire, and she knows, along with her colleague Senator Shaheen, that we need to have more certainty in the marketplace. And that's why we support the bill that would do that. We should vote on that bill. I also support Senator Kaine and Senator Carper's legislation, the Individual Marketplace Improvement Act to re-establish a federal insurance program. This bill would lower premiums by providing support for high-cost patients. Now, the Republican legislature in my state--both houses Republican--joined with the Democratic governor in our state and passed a similar state-based reinsurance program. I know Alaska, which by all accounts is a red state, that they have passed a reinsurnace program that recently got approval from this Administration. And just last week, as Senator Hassan knows, New Hampshire announced its plans to pursue one as well. So we can and we shold come together to pursue this as one change we can make positively for the nation.

Another, it is long past time that we do something about the rising costs of prescription drugs. I have a bill, and I see my colleague from Minnesota, Senator Franken, here as well. We have worked on this issue together and both have bills that are similar on this issue, and that is harnessing the negotiating power of 41 million seniors on Medicare to bring drug prices down. Right now, Medicare is literally banned from negotiating on behalf of 41 million seniors. The last time I checked, the seniors in my state have a lot of power. Forty-one million people, especially seniors, this is a lot of negotiating power.

Let's harness that because it will not just help bring prices down in the Medicare program, it will help down the line for all citizens, bringing in more competition. One way you do that is by dangling the prospect of competition from other countries. You can do it with a trigger based on the number of competitors you have in a certain market. You can do it based on an increase in price, or you can just do it. Senator McCain, who is certainly in our thoughts and prayers this week, he and I have long had a bill to allow Americans to bring in safe, less expensive drugs from Canada. That is very similar to the U.S. market. As I have often noted when I talk about this bill, we can see Canada from our porch in Minnesota. We can see those lower prices right across the border. Why in this country where we hav edeveloped so many lifesaving drugs, when we have done the research, when we put government money--taxpayer money--in the research, why do we have the most expensive drugs in the world? Well, I can tell you why, and that is because we haven't done anything about it here. Because for too long, the pharmaceutical companies have been able to have their way when it comes to legislation. And this is the end of that because finally the American people are starting to see this not just as campaign rhetoric but as a real problem. When four out of the top ten best-selling drugs have gone up over 100 percent in just the last ten years. Here are some more ideas.

Senator Lee and I have a bill that would allow again bipartisan, across the aisle, would allow temporary importation of safe drugs that have been on the market in another country for at least ten years when there isn't healthy competition for that drug in this country.

Senator Grassley, Republican of Iowa, and I have a bill to stop something called for "pay-for-delay," where big pharmaceutical companies actually pay off generic companies to keep less expensive products off the market. This is an outrage. I would challenge any senator to vote against that. I don't think they will. That's why we need a vote. And that is the perfect example of a bipartisan bill that could be included in a package of measure that could be improvements on the Affordable Care Act.

How about this one? The CREATES Act. Another bipartisan bill with Senator Grassley, Senator Leahy, Senator Feinstein, Senator Lee, myself, and many others. That would put a stop to tactics where companies, pharmaceutical companies refuse to provide samples that the generic companies need to develop new drugs. According to the Congressional Budget Office, this legislation would save taxpayers $3.5 billion. And the one I just mentioned on pay-for-delay, that would save taxpayers $2.9 billion. Why would we say to the taxpayers of this country we won't do that? We won't even allow it to come up for a vote? These are votes that the Senate should and must take.

Bringing up a bill that devastates the Medicaid program or that repeals big parts of the Affordable Care Act without a replacement does the opposite. It does nothing. These bills, a, b, c, d, e, or f do nothing in terms of bringing down pharmaceutical prices.

So what is this really about? Well, it's about the twins, indentical twins that I met yesterday from Cambridge, Minnesota. A small town. A town similar to, I'm sure, the towns that the presiding officer would find in his state or towns in New Hampshire or towns Senator Whitehouse would see in Rhode Island. This is identical twins. One of the twins is a pitcher and one of the twins is a catcher on their softball team. One of the twins found out just in the last few years that she has juvenile diabetes, and it's a very, very dangerous, dangerous thing to have at that young age. The other twin is perfectly healthy. So then the family had to go, of course, immediately to the doctor. They buy insulin. Insulin has gone up three times what it should in just the last few years. It is very difficult for them to afford now. They get the strips. They have to all of this, and the price keeps escalating. And to add to everything else, now this mom is worried that her daugher, one of her daughters, not two, will have a preexisting condition, could be kicked off insurance.

Think about that. Identical twins. Could be either one. You don't know which one. Is it the catcher? Is it the pitcher? It's a lottery. If you don't have healthcare like the Affrodable Care Act in place, it's like a lottery. You don't know which one of you is going to be kicked off insurance, not have insurance and get very sick and possibly die. That's what we are talking about here, and that's not what this country is about. Because it could happen to anyone, anyone in this chamber, anyone up in the gallery, anyone at home. You don't know when it's going to happen to you, or your sister, or your brother, or your neighbor, or your dad, or your mom, or your grandma, or your grandpa. That's why we have affordable healthcare insurance.

This debate is also about our seniors, our rual communities. As Senator Franken knows, we have heard time and time again from our rural hospitals from Aurora to Gilbert to Tower. I was up there recently, and that's what I heard about, the rural hospitals and how difficult it's going to be for them if any of these bills pass. I know it's something that our Republican colleague, Senator Collins, Capito, and Murkowski--all of whom have rural states, have expressed their real concerns about the impact of some of the proposed Medicaid cuts and what they would do in their states.

Opioids--the senator from New Hampshire here with me today, Senator Hassan and certainly Senator Whitehouse, both of them have been leaders in this area. That's why we put a bunch of funding from the CURES Act into opioid addiction treatments. That's why we passed the Comprehensive Additiction and Recovery Act on a bipartisan basis--one of the few bills that made it through last year.

We can't just run TV ads on it. You can't just put it on campaign brochures and then go out six months later and cut programs which provide the treatment for 32 percent of opioid medication-assisted treatments that we have in our state. We can't do that. You can't give beautiful speeches and go to press conferences and then make those kinds of cuts. And I know my colleagues on both sides of the aisle understand this.

So, Mr. President, this is a time where we can chart a different path forward, where we can end up where we should have begun but still standing, and that is to work together to find some positive changes for the American people to the Affordable Care Act. As I said the day it passed, this is the beginning and not an end. Let's seize this moment, open the door, work together for the American people.